Health, Runner Therapy

Runner Therapy: Long Run Knee

T_Runners_Knee_1Its that time of year again and famously the 20-milers have busted out all over the 5 boroughs. We are in full fall marathon swing and for most of us, this means bouts of ‘runners knee’ or what I call ‘long-run knee’. That mysterious dull ache that begins anywhere around the kneecap and can extend to the side and often the back of the knee.
Luckily, it usually isn’t major damage and there is plenty you can do.
Runners knee is primarily caused by tightness of the structures around the knee. The main culprits: the hip flexor, quad (specifically rectus femoris) and the dreaded IT Band. The tighter these structures get, the more the kneecap gets too much friction against the underlying bone. This can cause an arthritic-like reaction. When your joint isn’t getting enough rest, the cartilage on the back of the kneecap can’t repair itself quick enough, causing pain from inflammation.
Generally speaking, most knees are not ready for the pounding that they take during marathon season. Although it may seem you are ramping up somewhat slowly….a 15 miler one week, 17 another…if you have never trained before or rarely train this kind of mileage, it is a lot over a small period of time. Your knees will often notice!
What to do:
1. Roll your Iliotibial Band on a foam roll. Don’t roll over the bones at the top of the hip or close to the knee. They don’t appreciate the pressure. Pay close attention to other angles besides just down the side of the leg. Try rolling 45 degrees forward…not just straight down the side. This is  the line between the quadriceps muscle and ITB. Look for and roll out sore areas as if you are trying to get clumps out of dough with a rolling pin!
Several times a day 20x or so.knee
2. Stretch the hip flexor. 30 second easy stretches, don’t pull hard. Be sure to tuck your tail bone under and flatten the back keeping your core tight. This isn’t a big movement. Most runners have between zero and 15 degrees or so of hip extension. Don’t pull hard…some pressure is enough. Relax into it.
3. Stretch your quad. Standing or laying down, reach back and grab that ankle and pull back for 30 seconds, as often as you have time. Go easy and keep your knees next to each other.
4. Keep moving at your desk. Bend the knee…alot. Like once an hour! Give it some bending back and forth under your desk 20-30x. Sitting still makes you stiff with this condition. There is often pain on standing after sitting for any length of time…we call that ‘theatre sign’. So it’s best to keep moving!
5. Ice 20 minutes as often as you can. After a run, try to take an ice bath. Throw on your worst bathingsuit and get in tepid water. Slowly add ice until you start to freeze for 10 minutes!
6. Ladies, watch the high heels, but also watch the ballet flats. An inch of heel (men’s dress shoes and usually running shoes) are generally best.
7. Avoid aggravating activity. Generally this involves taking escalators over stairs (as another hallmark of this problem is less pain going up stairs rather than down). Try lowering your weekly mileage to a tolerable amount. Play with dropping the frequency and duration of runs to try to ‘catch up’ healing of the inflamed joint.
The more you stretch and ice and avoid aggravating activity, the quicker you will get back to normal. Physical therapy can speed up healing of a stubborn knee and teach you how to keep it from coming back. The best rule of thumb is to keep these stretches in your routine!
Have you had issues with your knees? If so, what helped? Do you find that after a certain distance your knees start to hurt?
- Marisa

(Marisa, a MS PT SCS ATC, is a member of  iRunnerBlog’s team and writes the Runner Therapy column, she is a physical therapist in private practice in midtown NYC called Dash Physical Therapy.  She one of only a dozen or so physical therapists  in the state of NY to be board certified in sports.)

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